Pharmacotherapy of endometriosis

Endometrioza je kronična bolest koja pogađa žene reproduktivne dobi te je karakterizirana prisutnošću ektopičnog tkiva endometrija izvan maternice, najčešće u zdjeličnom prostoru. Ove promjene uzrok su zdjelične boli, poremećaja reprodukcije i smanjene kvalitete života. Dijagnoza se potvrđuje laparoskopskom vizualizacijom i biopsijom lezije. Mogućnosti liječenja endometrioze uključuju medikamentozno, kirurško i kombinirano liječenje, dok se neplodnost liječi metodama potpomognute reprodukcije. Medikamentozno liječenje uključuje oralnu hormonsku kontracepciju, gestagene, analoge gonadotropin-otpuštajućeg hormona, danazol i nesteroidne protuupalne lijekove koji smanjuju bol i veličinu lezija te usporavaju progesiju bolesti. Lijekovi koji se istražuju kao terapijske opcije poput inhibitora aromataze, antagonista gonadotropin-otpuštajućeg hormona, selektivnih modulara progesteronskih i estrogenskih receptora, blokatora faktora tumorske nekroze alfa, antiangiogenetskih čimbenika, gama liganda receptora aktiviranog proliferatorom peroksisoma, statina, pentoksifilina i inhibitora matriks metaloproteinaze pokazali su se učinkovitima u smanjenju endometriotskih lezija na eksperimentalnim modelima, no čeka ih faza kliničkih ispitivanja. Kirurško liječenje provodi se kod neuspjeha medikamentoznog liječenja te kod opsežnih lezija, te se većinom provode konzervativne operacije kako bi se sačuvala reproduktivna sposobnost žena.Endometriosis is a chronic disease affecting women of reproductive age and is characterised by the presence of ectopic tissue outside of the uterus, most commonly in the pelvic space. These changes are cause of pelvic pain, reproductive disorders, and reduced quality of life. Diagnosis is confirmed by laparoscopic visualisation and biopsy. Treatment options for endometriosis include medical, surgical and combined therapy, whereas infertility is treated by assisted reproduction techniques. Pharmacotherapy of endometriosis includes oral hormonal contraception, gestagens, gonadotrophin-releasing hormone analogues, danazol, and nonsteroidal anti-inflammatory drugs that reduce pain and size of the lesion and slow down progression of disease. Drugs investigated as therapeutic options such as aromatase inhibitors, gonadotrophin-releasing hormone antagonists, selective progesterone and estrogen receptor modulators, tumor necrosis factor alpha blockers, antiangiogenic factors, peroxisome proliferator-activated receptor gamma ligands, statins, pentoxyfillin and matrix metalloproteinase inhibitors have been shown to be effective in reducing endometriotic lesions on experimental models, but the phase of clinical trials is still to be completed. Surgical treatment is performed in case of failure of medication treatment and in extensive lesions, and is mostly conservative to preserve the reproductive ability in women